Tuesday, January 28, 2014

Identify the Signs - Does Not Follow or Understand What You Say (starting at one year)

Being able to listen to and follow basic directions is an important skill for all children and the development of these skills starts at a very young age. Here is some information on typical development of listening skills, things you can do at home as well as red flags to watch out for.

Typical Development of Listening Skills

Starting at one year, your child should be able to comprehend a small number of words. For example, my son (almost 1) knows when I say "Where's daddy?" that he needs to look around the room and find my husband. When he sees him, he gets a huge smile on his face and we say "dada!!" But the important skill that he has is that he understands my question enough to respond by looking. Soon, he will point. Then, he will say "kitchen" and later he will say a sentence. But for now, he can listen to what I say and respond in some appropriate way.

Between one and two years old, your child will be able to follow simple directions like "get the shoe" or "push the car" or "come to mommy."  He will also be able to point to simple pictures in simple books. We enjoy reading simple books and right now I point to the pictures that I name. "Oh, see the frog!" or if he touches the page, whatever he points to I will name. In a few short months I will say "see the turtle!" and he will point to the turtle. In addition, kiddos at this age should be learning the major body parts (head, tummy/stomach, arms, legs, feet, hands).

After the age of 2, your child should be able to follow more complex two-step directions. The first type would be related directions where in order to do the second part of the direction, they have to do the first part. For example: get your shoes and bring them to me. Well, in order to bring them to me, they first have to get them. Or, pick up your cup and put it on the table. Same idea, you can't put the cup on the table without first picking it up. It naturally builds your child's skill of listening to longer commands while the concept is still pretty simple. The second type of two-step directions is non-related directions. This would be any two random directions that could be done separately. For example, get your cup and the blanket. Or put the doll down and sit at the table. Or put the ball in the basket and come to mommy.  Also at this age, your child should comprehending opposites: big/small, hot/cold, up/down, open/closed, etc... as well as understanding the word for almost every common object he encounters regularly.

Between 3 and 4 years old, your child should be able to follow those complex directions that now involve simple locations concepts (put the shoes in the closet or get the toy from under the bed) and he should be answering wh-questions (who questions with people answers, what questions with actions or nouns, where questions with location answers and why questions with a reason "because....").

After the age of 4 and up to age 5, your child should be following simple 3-step directions such as Get the forks and napkins and put them on the table. or Put on your shoes and shirt and go to the living room. He should be answering simple comprehension questions from the stories that you are reading. What did Sammy find at the park? or Where did Sally and John go with their grandma? or Why was Emily so sad at the beginning of the story? In addition, he should understand what you are saying to him most of the time. For example, if you say, After the park we are going to meet up with Bobby and have ice cream. He should understand and remember what you said.

What can you do at home?

For younger children it's important to make sure that you are letting them know that they did what you asked. When we get excited when Baby W finds daddy and we say "dada!!!!!" He's beginning to make the connections between my words and his responses. Also, if I say "get the car" and he goes for his ball, I'll say "that's the ball (pause). Let's get the car" and then I help him complete the direction by giving him the car and finish by says "you have the car!" If it's clear that he is more interested in the ball than the car, I can then say, "let's get the ball" and then we'll play the game that he is interested in. But having him correctly follow my direction helps him make the connection between the verbal word and the object and it teaches him that following directions is an important thing.

Once your child is one he will start following those simple directions. Make sure you are giving him things to do and not doing everything for him. I've worked with parents who will put their child's shoes on and do all of the work. They get the shoes, they set the child on the chair, they get the child's foot and put the socks and shoes on. That's a lot of work! What I teach them to do is (at first) say what you are doing. "Ok, lets get our shoes! Now we sit down. I've got your foot!! We'll put the sock on. Now we'll put the shoe on! All done!" Then, when your child is working on developing the skill of following directions, you tell them one step at a time. "Get your shoes" "bring them here" "sit down" "give me your foot!" During this time you are beginning to work on body parts, too. I love to work on body parts while I am dressing Baby W or playing a little tickle-game. I know some parents who enjoy working on body parts during bath time.

From 2 to 3, you'll still be working on following direction, but if your child is struggling with the two step directions, you can model what you want done. "Pick up the cup and put it on the table" as you are picking up the cup and putting it (dramatically) on the table. Then you put it back where it was and have your child follow the direction. And then your praise them with claps and cheers! I'd like to add that there is a difference between not following the direction because of the complexity of the two-steps and because your child is being non-compliant (a nice word for stubborn!) - but that's for another day.

From 3 to 4, you will still be working on following directions (I think this is a life time goal for kiddos!) but at this age you'll be adding in simple prepositions (in, on, under, off of). You can play fun games by tossing bean bags, pillows or stuffed animals and trying to get them to land in certain places or while playing with toys set up scenes and direct your child to put the toys in a various locations. I like to play with cars and have them drive on the couch and under the couch and fly off of the couch and then they can sleep in the couch (between cushions). If you have a bucket of cars you can gently suggest where your child put them without it seeming like a "hey, we are working on following directions today" It can be a whole lot more fun than that! To work on wh-questions, I like to focus on one type at a time while they are developing. What-questions seem to be the easiest and can be answered with nouns (What is that? or What did he find?) or actions (What was Sam doing? or What did you do at the beach?). Then where-questions. It's easiest to start with location answers like: Where did we go today? (school!) or Where do you want to eat? Then you can work on prepositions Where are your shoes? (in the closet) or Where does the pillow go? (on my bed). Next do who-questions. You can start with pictures of familiar people and ask Who is this? (Nana!) and then ask the questions when there is not a picture to help, like Who are we going to go see today? (Mimi!). Finally, why-questions...you'll want to make sure that you don't get the answer "because" as the only answer! You can start by allowing simple answers (partial answers) Why do we need to wash our hands? "to clean them" But then after your child is consistently answering with short answers, start requiring  longer answers "We need to clean them." or "Because we need our hands to be clean."

As your child grows, what he understands will get more complex. After his 5th birthday you can start giving him 3 step directions. Sometime I have parents who are concerned that that may be too much for their child, but you have to understand that once they are in school the demands that are placed on them in terms of following directions is very complex. Keeping it simple at home forever will make it that much more difficult when they get to school. The typical Kindergarten child will have to follow directions like "clean up your area, go to your seat and get out your crayons." This involves remembering those directions while he follows them, holding them in memory for many minutes and doing those 3 (and sometimes more) steps that have nothing really to do with each other. Practicing this skill at home can make following directions at school easier. Also, you can work on simple comprehension questions about a short story you have just read. If your child has difficulty remembering the answers, you can flip back in the story so he can use the pictures to help (that's not cheating, that's a good strategy for pre-readers!). You can also re-read the page where the answer is. To simplify it a little more you can ask a question at the end of each page or set of pages. Finally, to see if your child does understand your longer sentences you can ask him to repeat what you said or ask "What are we doing after the park" (do you remember? We are getting ice cream with a friend!) or at the park you can ask "what are we doing next?" Helping your child with abstract concepts like the sequence of events for the day is an important skill!

Red Flags

Infant - does not attend to sounds in his environment
Toddler - not responding to directions or poor understanding of common vocabulary (especially toys)
Preschooler - not following two part directions or difficulty answering questions
School Age Child - not able to follow two or three part directions, difficulty answering questions about stories that have been read to him

If your child seems to have significant difficulties with the skills listed in his age range or he demonstrates any of the red flags, please talk with your child's pediatrician and seek out a professional Speech Language Pathologist in your area. If you are in the Central Florida area, feel free to contact me. If you are not, or you are looking for more resources, the American Speech-Language Hearing Association has a pro-search feature. Check that out here.

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